05 December 2018

Hygiene Promotion Campaigning in Prolonged Encampments

Author/Compiled by
Luisa Muenter (cewas)

Executive Summary

Throughout the stages of a humanitarian crisis, refugee populations and Internally Displaced People (IDPs) in camps must be safeguarded against water, sanitation and hygiene (WASH)-related diseases through systematic and participatory hygiene promotion campaigns. In contrast to early-stage emergencies, where hygiene promotion campaigns must focus on addressing the riskiest practices for diarrheal diseases transmission, hygiene promotion campaigns in prolonged encampment settings should address a wider scope of health risk factors and hygiene issues, including environment-related diseases. The range of communication and participatory methods and approaches, too, should be more diversified. This factsheet details the components of a hygiene promotion campaign and explains the relevant working steps for implementation, monitoring and ongoing assessment.

Advantages
Facilitates guidance for coordinating a response between humanitarian actors;
Promotes increasing participation and community mobilisation which will enable and sustain long-term behavioural change of the refugee and IDP population and will improve sustainability of the intervention;
Hygiene promotion campaigns are pivotal to water supply and sanitation interventions;
Provides clarity and concrete steps for soft- and hardware approaches.
Disadvantages
Coordination between water, sanitation and health sectors for hygiene promotion planning and for the dissemination of harmonised information can be challenging.
It can be costly to properly plan a hygiene promotion campaign and specific skills are required.
Limited financial resources are often a major challenge in prolonged encampments, which are often referred to as the “forgotten crises”.

Introduction

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In Prolonged Encampments, the systematic and participatory planning approaches to hygiene promotion which are typically implemented in earlier emergency phases (see invalid link factsheet), need to be maintained and adapted to ensure continuation of positive behavioural change around household, food and personal hygiene, towards achieving the The Sphere Project Standards Minimum Standards (UNHCR 2015a, THE SPHERE PROJECT 2011, GWC 2009). The refugees and Internally Displaced People (IDPs) should be empowered with the knowledge, resources, willingness and practice to continue to prevent diseases of concern and adjust to changing conditions in prolonged encampment settings (HARVEY 2015, WHO AND WEDC 2011).

Addressing Hygiene Promotion in Prolonged Encampments

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Depending on the stage of the humanitarian crisis (early emergency, later/post-acute emergency, prolonged/protracted crisis situations), hygiene promotion strategies vary in terms of intensity and scale of the intervention (GWC 2009).

Prolonged encampment settings are often referred to as “forgotten crises” and often face challenges of a lack of access, inappropriate interventions, uncoordinated response and tight financial resources (CRONIN et al. 2008). Awareness of the implications of resource gaps in water, sanitation and hygiene services is often lacking (CRONIN et al. 2008). A specific challenge for hygiene promotion in prolonged encampments is that members of the camp population may become worn down by the protracted nature of the crisis and consequently, their behaviours around hygiene may deteriorate. Furthermore, often the stakeholders lack a shared vision for the camp, partly due to protracted disputes, political differences and conflict of interests (IOM, NRC AND UNHCR 2015). As such, strong coordination of WASH stakeholders is particularly important but at the same time presents a major challenge (CRONIN et al. 2008; IOM, NRC AND UNHCR 2015). Targeted priority interventions that address the persistent or newly emerging specific risk factors need to be taken (CRONIN et al. 2008).

In prolonged encampment settings, the focus of hygiene promotion campaigns lies no longer on life-saving and protection but rather on meeting comprehensive needs for hygiene and maintained health beyond basic needs (including, for example, environment-related diseases). In addition, humanitarian assistance in prolonged encampments must focus on the affected population’s rights and essential economic, social and psychological needs (UNHCR 2005). In prolonged encampments, one good model for humanitarian assistance is to move away from traditional assistance towards focusing on promoting self-reliance, creating economic opportunities and strengthening cost-sharing models (KONYNDYK 2005).

Community Engagement Around Hygiene

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As prolonged encampments are more stabilised than Camps, it is more important than ever to engage the affected communities and to promote long-term health benefits through sustained behavioural change (HARVEY 2015; BIRAN et al. 2012). In camps where investments in behavioural change programs were made during the immediate emergency phase, the population is often seen to practice good hygiene behaviour for many years. Investment in behavioural change interventions are a cost-effective and sustainable method of intervention and thus very relevant for prolonged encampment settings (CRONIN et al. 2008). This is especially important because the affected population may become worn down by the protracted nature of the crisis, which may cause them to face psycho-social problems related to unemployment, unequal access to employment possibilities or alcohol abuse (IOM, NRC AND UNHCR 2015). This may result in an increased risk for exploitation, abuse or illness (ROBINSON AND ALPAR 2009, UNHCR 2015b, DEMO 2009). Community mobilisation frameworks such as Community-Led Total Sanitation (CLTS) and Participatory Hygiene and Sanitation Transformation (PHAST) present widely used and tailor-made methods of hygiene promotion that are very appropriate for prolonged encampment settings (PIN 2012).

Hygiene Committee or Health Clubs

All WASH programs should, if possible, have hygiene committees or health clubs developed and run in cooperation with the refugee and IDP population (UNHCR 2015b). This can facilitate participation of refugees and IDPs in the (re)design and management of WASH services, in continued disease prevention and in hygiene education (HARVEY 2015, BIRAN et al. 2012). Community-based WASH committees can encourage and support refugee populations to take an active role in Ensuring Appropriate Operations and Maintenance Services (O&M) of sanitation facilities, which helps to ensure good hygiene in the long-term (IOM, NRC AND UNHCR 2015). All programs should have a gender-balanced and representative committee responsible for promoting hygiene and implementing hygiene promotion campaigns. If such committees are set up, clear roles, responsibilities, rules and regulations must be defined for both professional hygiene promoters and community mobilisers from the refugee/IDP population (see invalid link factsheet).

Communication and the Role of Education

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The range of communication and collaboration platforms and approaches used for hygiene promotion should be diversified in prolonged encampment settings and should include Media Campaigns - Radio (DC)/TV broadcast, public announcements, Media Campaigns - Posters and Flyers (DC), signs, paintings and cartoons, meetings and Focus Groups, celebrations, traditional and community events, film and video presentations, as well as dramas, role plays, games and songs (IOM, NRC AND UNHCR 2015). The communication methods should always be chosen based on a thorough, participatory assessment of the cultural norms of the refugee/IDP population. Education clusters are often activated in prolonged encampment situations and this can open a new avenue for hygiene education (see School Campaigns (DC) factsheet) (IOM, NRC AND UNHCR 2015).

In Mae Le Camp in Thailand, computer classes are provided to Burmese refugee youth to prevent risky coping mechanisms and to build their capacities. Source: ROBINSON AND ALPAR (2009).

In Mae Le Camp in Thailand, computer classes are provided to Burmese refugee youth to prevent risky coping mechanisms and to build their capacities. Source: ROBINSON AND ALPAR (2009).         

Planning and Preparation – A Phased Approach

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Mobilising the community for hygiene promotion is best done in a phased approach that is adapted to the stage of the emergency or humanitarian crisis (HARVEY AND COLONI 2015). In the medium- to long term post-emergency phase of prolonged encampments, hygiene promotion should follow an approach more in line with development settings, involving continuous assessment, analysis, design, implementation, monitoring and evaluation of risks (a concept commonly referred to as Linking Relief, Rehabilitation and Development LRRD) (HARVEY 2015).

Defining the Campaign Strategy

Every camp should have a context-specific hygiene promotion strategy set up in the early emergency stage that justifies WHY hygiene promotion is important in the specific context, HOW the key hygiene risk practices have been identified, WHO the priority at-risk groups are, WHAT the most effective hygiene promotion approaches and activities are, HOW the target activities for each at-risk group will be carried out and HOW the effectiveness of the plan will be monitored (HARVEY 2015). If the strategy has not been set and defined during the early emergency stage, this should be rectified for prolonged encampments. The following components should be addressed by the strategy and prioritised according to a continuous risk (re-)assessment: community and individual action, Ensuring Appropriate Operations and Maintenance Services, Selecting and Distributing Hygiene Items, monitoring, community participation and communication with WASH stakeholders.

Campaign Planning and Revision

While planning activities of the Camp Hygiene Promotion Campaigning in Early-Stage Emergencies focus on preparation (assessment, consultation, definition of goals and objectives, identification of target audiences and stakeholders, campaign planning and recruitment) and on addressing basic needs, planning activities in Camp Hygiene Promotion Campaigning in Later-Stage Emergencies and prolonged encampment settings focus on ensuring that the hygiene promotion campaign goes beyond addressing basic needs towards meeting all locally relevant health and hygiene issues. The campaign should continue to work towards meeting its relevant goals through implementation, monitoring and adaptation of the campaign as required (adapted from GWC 2009 and HARVEY 2015, BIRAN et al. 2012).

The steps for addressing campaign implementation and adaptation relevant for prolonged encampments include (adapted from GWC 2009 and HARVEY 2015, BIRAN et al. 2012):

Implementation and ongoing assessment of the situation
  • Conduct ongoing assessments to understand the motivation factors behind positive behavioural change around hygiene.
  • Assess the heterogeneity in the camp population and the associated behaviour and risk practices.
  • Obtain quantitative data and carry out a systematic data collection in a participatory manner and in coordination with other sectors.
Monitoring
  • Monitor the hygiene promotion activities (e.g. distribution of hygiene kits, installation of toilets) and people’s level of satisfaction.
  • Monitor and evaluate hygiene promotion campaigns against hygiene-related indicators on safe access to quality sanitation and on satisfactory living condition (UNHCR 2015a). The relevant indicators for the prolonged encampments (referred to in standards as “post emergency stage”) include:
    • ≥ 90% of households have soap present in the house (which can be presented within 1 minute),
    •  ≥ 80% of households can name 3 of the 5 circumstances in which it is critical to wash hands
    • ≤ 500 refugees/IDPs per hygiene promoter
    • Availability of 450 grams/person/month of soap. Actual needs are to be determined based on monitoring results.
Adaptation
  • Refine the campaign based on the changing situation and move towards more interactive methods of communication and participation in comparison to earlier emergency stages.
  • Based on an assessment of the heterogeneity, communication should be adapted to target the specific segments of the population identified to display certain risk practices.
  • Rapidly adapt the intervention and campaign based on monitoring outcomes and empower the communities to maintain their longer-term hygiene promotion structure (e.g. committees).
  • Continue training and monitoring and adapt approaches as necessary.

Promoting the Maintenance of Good Hygiene Practices in the Long-term

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To ensure that the hygiene promotion campaign promotes practices that can be sustained in the long term, the following points should be considered (IA 2014):

  • Use multiple communication methods and make use of hygiene promoters, schools, women’s groups, youth groups and mass media;
  • Carry out multi-sector planning and delivery together with health, child protection, livelihoods and non-food items sectors;
  • Increase participation and decision making of beneficiaries;
  • Use a child-centred approaches;
  • Approach disease monitoring and awareness campaign in an integrated health and education manner;
  • Support and strengthen WASH committees and health clubs;
  • Monitor and conduct impact assessment and use the information gathered in programme planning and adapting hygiene promotion campaigns.
  • Ensure systems are in place for Operation and Maintenance (O&M) of facilities to enable maintaining good hygiene practices (see Ensuring Appropriate Operations and Maintenance Services factsheet).

The Role of Ongoing Assessments and Epidemiological Studies

Achieving long-term behavioural change can be supported by conducting hygiene Knowledge, Attitude and Practice (KAP) surveys and ongoing household assessments of the camp population. The information can be used to improve the targeting of beneficiaries, bringing awareness to Preventing Gender-Based Violence (Camps and Prolonged Encampments) and facilitating coordination with the partners, refugees and local authorities (EUROPEAN COMMISSION 2014). Moreover, detailed epidemiological studies can help to demonstrate the cost-benefit payback of effective hygiene promotion (EUROPEAN COMMISSION 2014). Such interventions help focusing the response to health risks specific to the camp and given context.

Hygiene promotion session in Kurdistan in Darashakran refugee camp. Source: ACF (2014).

Hygiene promotion session in Kurdistan in Darashakran refugee camp. Source: ACF (2014).                               

Planning Timelines

Hygiene promotion plans should be revised every six months based on monitoring outcomes (HARVEY 2015).

Applicability

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The guidance presented in this factsheet is applicable to Prolonged Encampments

Library References

Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya

The International Rescue Committee (IRC) launched an intervention to improve WASH provision in prolonged encampments. The three camps targeted included a camp in Ethiopia with refugees from Eritrea established in 2001, a camp in Kenya with refugees from South Sudan, Ethiopia, DR Congo and Somalia which was established in 1992, and a camp in Thailand with Burmese refugees established in 1989. The IRC was responsible for sanitation provision in these camps, implementing hygiene education activities in all camps by recruiting staff from the camp population. These staff then received annual training on the topics they were responsible for training. These staff carried out hygiene communication according to IRC`s weekly schedule of house visits, small group discussions, and broadcasts of hygiene messages. Their strategy was to meet a maximum amount of people through the hygiene education delivery.

BIRAN, A. ; SCHMIFT, W. ; ZELEKE, L. ; EMUKULE; H. ; PARKER, J. ; PEPRAH, D. (2012): Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya. In: Journal of Tropical Medicine and International Health: , 17:9. URL [Accessed: 10.11.2016]

A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators – the need for integrated service provision

International Organization for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

CRONIN, A. ; SHRESTHA, D. ; CORNIER, N. ; ABDALLA, F. ; EZARD, N. ; ARAMBURU, C. (2008): A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators – the need for integrated service provision. In: Journal of Water and Health: URL [Accessed: 26.10.2016]

Water, Sanitation and Hygiene. Meeting the challenge of rapidly increasing humanitarian needs in WASH. DG ECHO Thematic Policy No.2

This thematic policy document provides information on meeting the challenges of rapidly increasing humanitarian needs. It provides information on basic principles of humanitarian response, emergency response and preparedness and response in acute, post-acute, protracted, and chronic crises, key determinants for interactions, guidance on coordination, advocacy, decision trees, and technical guidelines. It provides various insights on operations and maintenance planning for humanitarian crisis needs. The EC humanitarian WASH assistance follows the following objectives: 1) To ensure timely and dignified access to sufficient and safe WASH services for populations threatened by on-going, imminent or future humanitarian crises, and to increase their resilience to withstand water stress and shocks. 2) To implement measures to prevent the spread of WASH related diseases in populations threatened by on-going, imminent or future humanitarian crises. 3) To enhance the impact, relevance, efficiency and effectiveness in the delivery of WASH assistance by strengthening the capacities of the humanitarian aid system, including its coordination mechanism.

EUROPEAN COMMISSION (2014): Water, Sanitation and Hygiene. Meeting the challenge of rapidly increasing humanitarian needs in WASH. DG ECHO Thematic Policy No.2. Brussels: European Commission URL [Accessed: 31.10.2016]

Hygiene Promotion in Emergencies

This Global Wash cluster manual provides training materials and handouts for facilitators to train hygiene prompters. It contains advice on hygiene promotion related non-food items selection and delivery. The WASH related non-food items briefing paper addresses maximizing benefits of the distribution of hygiene items, selection of hygiene items, guidance on distribution and tips for improving distribution of items, as well as suggestions for improved coordination.

GWC (2009): Hygiene Promotion in Emergencies. A Briefing Paper. New York: Global WASH Cluster URL [Accessed: 08.11.2016]

Chapter 8: Hygiene Promotion

This briefing paper provides basic information on Oxfam`s hygiene kits. It introduces the types of hygiene practices that are enable through the items in the kits and prices details on the contents of Oxfam’s basic hygiene kit.

HARVEY, B. (2015): Chapter 8: Hygiene Promotion. In: HARVEY, B. ; (2015): UNHCR WASH Manual. Geneva: . URL [Accessed: 25.11.2016]

Camp Management Toolkit

International Organisation for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

IOM NHCR UNHCR (2015): Camp Management Toolkit. Genva: International Organization For Migration URL [Accessed: 25.08.2016]

Water, Sanitation, and Hygiene (WASH) Manual

The following guidelines are a sum-up of PIN experience in WASH projects in Afghanistan, Ethiopia, Congo, Angola, Cambodia and Sri Lanka – programs are implemented in rural, often remote areas. The guidelines are program specific and reflect experience from implementation, but can generally be useful in project designing and proposals.

PIN (2012): Water, Sanitation, and Hygiene (WASH) Manual. The Cheque Republic. Version 7.. Prague: People in Need URL [Accessed: 11.12.2016]

Hygiene promotion in emergencies

This guidance document is for managers of WASH programs to manage their hygiene promotion campaigns programmes. This clear and well-presented guidance document provides background information for hygiene, hygiene practices in camps, and the F-diagram. It also concisely summarises types of evaluation and monitoring. It presents pertinent information on principles of hygiene promotion, selection and training facilitators, methods of hygiene and sanitation promotion, planning guidance for hygiene promotion campaign and method of implementing a plan of action. Further guidance is provided on how to analyse assessment information and available participatory tools that may be used.

WHO WEDC (2011): Hygiene promotion in emergencies. In: WHO ; WEDC ; (2011): Technical Notes on Drinking-Water, Sanitation, and Hygiene in Emergencies. Geneva: . URL [Accessed: 04.11.2016]
Further Readings

Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya_FR

To evaluate sanitation and hygiene interventions in prolongued encampment situations, data was collected on handwashing based on structured observations, questionnaires on WASH, and discussions with mothers. The study examined a camp in Kenya, one in Ethiopia and one in Thailand. The study looked at the prevalence of handwashing, priority uses of soap and prevalence of open defecation. The conclusion of the study identified sub-optimal rates of “safe” handwashing, scarcity of soap and heterogeneity with respect to education and place of origin of refugees in terms of their level of safe hygiene practices.

BIRAN, A. ; SCHMIFT, W. ; ZELEKE, L. ; EMUKULE; H. ; PARKER, J. ; PEPRAH, D. (2012): Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya_FR. In: Journal of Tropical Medicine and International Health: , 17:9. URL [Accessed: 10.11.2016]

A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators – the need for integrated service provision

International Organization for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

CRONIN, A. ; SHRESTHA, D. ; CORNIER, N. ; ABDALLA, F. ; EZARD, N. ; ARAMBURU, C. (2008): A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators – the need for integrated service provision. In: Journal of Water and Health: URL [Accessed: 26.10.2016]

Camp Management Toolkit

International Organisation for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

IOM NHCR UNHCR (2015): Camp Management Toolkit. Genva: International Organization For Migration URL [Accessed: 25.08.2016]
Case Studies

Phase out a strategy for post emergency plan. Sheikhan IDP camp Water, Sanitation and Hygiene

In the Sheikhan camp, the classic hygiene promotion activities which occurred during the emergence phase of the camp consisted of creating WASH committees, providing hygiene promotion activities aimed at familiarising the population with latrine use and maintenance and basic body hygiene. To prepare for the longer term and anticipate decreasing available funds, ACF expanded the scope of WASH software activities towards full participation and to build up the capacity of the population. The tools use to build capacity included advocacy, accountability to the population, community participation, capacity building and behavioural change communication. ACF trained both the WASH committees of hygiene promoters as well as the WASH clubs from the members of the community to facilitate a progressively reducing active support in the community.

ACF (2014): Phase out a strategy for post emergency plan. Sheikhan IDP camp Water, Sanitation and Hygiene. Duhok: Action Against Hunger URL [Accessed: 01.12.2016]

Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya

The International Rescue Committee (IRC) launched an intervention to improve WASH provision in prolonged encampments. The three camps targeted included a camp in Ethiopia with refugees from Eritrea established in 2001, a camp in Kenya with refugees from South Sudan, Ethiopia, DR Congo and Somalia which was established in 1992, and a camp in Thailand with Burmese refugees established in 1989. The IRC was responsible for sanitation provision in these camps, implementing hygiene education activities in all camps by recruiting staff from the camp population. These staff then received annual training on the topics they were responsible for training. These staff carried out hygiene communication according to IRC`s weekly schedule of house visits, small group discussions, and broadcasts of hygiene messages. Their strategy was to meet a maximum amount of people through the hygiene education delivery.

BIRAN, A. ; SCHMIFT, W. ; ZELEKE, L. ; EMUKULE; H. ; PARKER, J. ; PEPRAH, D. (2012): Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya. In: Journal of Tropical Medicine and International Health: , 17:9. URL [Accessed: 10.11.2016]
Training Material

Camp Management Toolkit

International Organisation for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

IOM NHCR UNHCR (2015): Camp Management Toolkit. Genva: International Organization For Migration URL [Accessed: 25.08.2016]

Introduction to Hygiene Promotion: Tools and Approaches

This is a manual with training material and handouts for facilitators to prepare training for hygiene promotion at different levels. The manual provides hygiene promotion training materials including tools and approaches for training including human resources planning, recruitment, and management, WASH generic job description for hygiene Promotion staff and volunteers, and a list of essential hygiene promotion equipment for communication.

GWC (2009): Introduction to Hygiene Promotion: Tools and Approaches. Geneva: Global WASH Cluster URL [Accessed: 08.11.2016]
Awareness Raising Material

Water, Sanitation, and Hygiene

The Norwegian Refugee Council introduces the field of water, sanitation, and hygiene in humanitarian crises. It provides an overview of what humanitarian actors activities in the field can include and provides relevant news on the humanitarian crises and humanitarian aid interventions.

NRC (2017): Water, Sanitation, and Hygiene. Oslo: Norwegian Refugee Council URL [Accessed: 01.05.2016]

Alternative Versions to